Prenatal care weighs needs of 2 patients

Ethics Forum. Sept. 3, 2007.

How should you respond when a pregnant woman's habits impact her fetus?

A pregnant woman's nonadherent behavior and lifestyle put her fetus at risk and point distinctly toward a riskier-than-average delivery. What ethical and professional principles help in managing this patient's care?

Reply:

Here is an (unfortunately) representative set of circumstances. A newly registered patient presents for prenatal care late in her third pregnancy. Her intake history tells a complicated obstetrical/psychosocial story. She states, "This baby better be born healthy; my first boy has been taken by DSS because my baby girl died inside me, even though those doctors did an emergency C-section. They said it was from drinking and drugs ... they said it was 'abruptio,' whatever that means. I wanted to sue them, but ain't no lawyer wants to take a poor woman's case. But, anything wrong with this baby and I will sue all y'all."

How, indeed, ought the health care professional respond?

Even in the best of circumstances, the praxis of obstetrics retains an element of uncertainty as to outcome. Conscientious, even compulsive adherence to those evidence-based practice guidelines promulgated by our professional organizations (the American Medical Association, American College of Obstetricians and Gynecologists and the American Academy of Family Physicians) does not guarantee perfect results in all situations.